Frequently Asked Questions

I'm going to have an ankle arthrodesis (fusion) using bone taken from my hip. The surgeon and the nurse must have spent three times as much time telling me about all the problems I could, might, will have where they take the bone from and hardly anything about the ankle. If this is such a big problem, why don't they find some other way to do it?

There are new and wondrous developments in the area of bone grafts including new techniques for bone grafting in the foot and ankle. But sometimes, it's still easier, faster, and better to go with the old tried-and-true method of harvesting bone from the pelvic bone. Most often, bone is taken from the iliac crest. The iliac crest is the top of the pelvic bone -- it's located where you place your hands on your hips. Bone harvested from this area is plentiful but can cause excessive bleeding and postoperative pain. For some procedures, like ankle and foot reconstruction, the patient could go home the same day if it wasn't for problems with the bone graft donor site. Because of major complications with graft site pain, deep infections, ugly scars, and sensory loss, surgeons started looking elsewhere for another source of autograft with fewer problems. With the advances in graft techniques, it's now possible to take bone from places other than the iliac crest. The most popular sites have become the front of the tibia (lower leg bone) just below the knee, the lower part of the tibia (just above the outer ankle), the calcaneus (heel bone), and the greater trochanter (area of bone at the top of the femur or thigh bone). If the graft donor site is close to the area where the donor bone is needed, it's considered a local source of autogenous graft material. If the bone is harvested from an area away from the main surgical site (usually in order to get more bone), it's referred to as a regional bone graft. Despite the drawbacks and potential problems, harvesting bone from the iliac crest has several advantages. For one thing, it contains two types of bone: cancellous and cortical. Cancellous bone is the spongy, less dense bone between the outer layer (perisoteum) and inner layer (bone marrow). Cancellous bone has a better blood supply and that's helpful in getting new bone cells to survive. There's also more of it compared with cortical bone. And it is easier to form and shape cancellous bone around difficult or tight spots during bone grafting procedures. This last benefit is important when working in the ankle because of the many oddly shaped bones and joints. Cortical bone is the stronger, denser, supportive bone that forms the outer shell of most bones. It provides good mechanical support. But with less of a natural blood supply, it is much slower to build blood vessels for the new bone. It's likely that the surgeon and his nurse explained some of these things to you. But whenever new information is presented the first time, the importance and specifics don't always sink in. Don't hesitate to ask again for a quick review of the important points and how/why they matter in your case. The fact that they spent so much time making sure your understand all the potential risks is a good sign that the surgeon will do everything possible to prevent complications and problems.

Timothy C. Fitzgibbons, MD, et al. Bone Grafting in Surgery About the Foot and Ankle: Indications and Techniques. In Journal of the American Academy of Orthopaedic Surgeons. February 2011. Vol. 19. No. 2. Pp. 112-120.

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